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  • Predictive analytics takes another step

    As analytics expand in healthcare, it seems that Lao Tzu, 6th Century BC Chinese Poet’s aphorism that“Those who have knowledge, don’t predict. Those who predict, don’t have knowledge” might be running out of steam. A report in iHealthBeat says that Boston Children’s Hospital (BCH) is testing a new patient monitoring system that predicts changes in patients’ conditions before alarms notify health workers. The goal is to take some of the guesswork out of data from several monitoring systems.

    BCH is working with Etiometry, a Boston-based start-up specialising in healthcare analytics, to develop the Stability Index (SI), the predictive analytics model. Attending physicians in BCH’s cardiac intensive care unit are testing the Stability Index.

    The SI uses algorithms to analyse all of the data gathered from patient monitors, including heart rates, respiratory rates and other vital signs. Physicians can select the parameters they want to measure. SI then produces its risk assessment on a numerical scale. The most stable patients have a score of 0, the least stable score 4.

    Predictive analytics is an expanding activity. It needs a role in all African countries’ eHealth investment plans, even though it’s developing at a steady rate. As Oscar Wilde said “To expect the unexpected shows a thoroughly modern intellect.”

  • Wikipedia’s part of health’s Big Data

    The headline in PLOS Computational Biology is clear. “Wikipedia Usage Estimates Prevalence of Influenza-Like Illness in the United States in Near Real-Time.” Another big data initiative grabs headline coverage.

    A study by David J. McIver and John S. Brownstein from Boston Children’s Hospital, on the level of influenza-like illness (ILI) in the USA monitored the number of times people accessed specific influenza- or health-related Wikipedia articles each day between December 2007 and August 2013. They compared the data to official ILI activity levels provided by the Centers for Disease Control and Prevention (CDC). The National Institutes of Health and National Library of Medicine financed the study.

    The researchers’ Poisson model accurately estimated the ILI activity up to two weeks ahead of the CDC. The difference in the two sets of data was only 0.27% over 294 weeks. But, Wikipedia-derived ILI models performed well for events with high media coverage, such as the 2009 H1N1 pandemic, and unusually severe flu seasons, such as in 2012–2013.

    Google’s been estimating flu too. Wikipedia accurately estimated the week of peak ILI activity 17% more often than Google Flu Trends. It was also more accurate than Google in measuring ILI intensity. Google Flu Trends’ methodology provides global data.

    Study’s like these point to the considerable potential of Big Data for African countries. They provide the evidence for an extra dimension for their eHealth strategies and a new line in eHealth investment plans.

  • EHRs create extra jobs

    Scribes have been part of society and learning for eons. Wayne Gerard Trotman said “May the scribes record it,” acknowledging their role in his book Veterans of the Psychic Wars. Now, doctors in the USA are employing them to help with EHRs.iHealthBeat has a report that specialist employment agencies are showing growth in demand of up to 50% for medical scribes. It summarises a blog on Shots, a National Public Radio (NPR) site.

    Dr Devesh Ramnath, an orthopaedic surgeon in Dallas, recently switched to EHRs. He found he was“Focused on just trying to get the information in, and not really focusing on the patient anymore.” He was also spending two to three hours every clinic on his EHRs. His solution was to employ a medical scribe. Now, Dr Ramnath examines patients and his scribe sits quietly in the corner, typing notes and speaking into a handheld microphone to compile records for review.

    It may be that EHRs’ potential time saving benefits have taken a hit. They now need rigorous scrutiny as part of the business case. “May it be written. May it be done” isn’t just for psychic wars.

  • Is Nigeria Africa’s new top student?

    Since the announcement that Nigeria is now the wealthiest country in Africa with a GDP of $509 billion, the country has received global attention. First Oracle announced its commitment to the country. Now Microsoft has re-emphasized its commitment to the continent and more specifically Nigeria.

    “We have invested heavily in ensuring that we have a good impact on the local economy. This includes job creation, support for the youth in Nigeria, software donations to NGOs and the development of local innovation,” said Microsoft Nigeria’s General Manager, Kabelo Makwane.

    Commenting on Microsoft’s strategy for Africa, Makwane said, they are looking to shape the next 20 years on the continent through the Microsoft 4Afrika Initiative. It was launched a year ago and has three pillars: 21st century world-class skills, providing affordable access and fostering local innovation.

    While being the most popular kid on the school ground is always fun, what will the real life benefits be? Will the standard of living increase for Nigeria’s population? Will the growing economy help support and develop a more efficient healthcare system? Microsoft 4Africa Initiative strives to foster local innovations, so let’s hope that it includes the development of eHealth services.

  • Cyber-security keeps worrying USA and business, so healthcare

    Cyber-security seems to be a worry becoming an obsession. Most companies, including healthcare organizations, see cyber-crime as bigger than other big business risks, say the findings of a survey by thePonemon Institute a research centre based in Michigan and dedicated to privacy, data protection and information security.  Some 94% of the 80 healthcare organizations in the survey said they were aware of one data breach or more over the last two years. The estimated cost was $6.78 billion a year. Ponemon’s findings include:

    Protecting against the financial cost of cyber-risks ranks as high as, or higher than other insurable risks Responsibility for managing cyber-risk is moving outside the ICT team, with risk management or compliance officers taking it on Most companies either have cyber security insurance or are considering it About 30% of companies are not currently interested in insurance.

    Healthcare and pharmaceuticals were the survey’s third-largest industry group. FierceHealthIT reports that privacy experts speaking at the Healthcare Privacy Summit earlier this summer said healthcare organizations are too reactive towards health data security. Since then, asurvey of the cyber-security workforce by Semper Secure, a public-private partnership, found that healthcare is fourth-largest employer of cyber-professionals after government, manufacturing and defence with aerospace. This may indicate a shift in emphasis. This sounds encouraging, but according to The Economist, just more cyber-professionals are not enough. They need a change in their approach. Many executive’s believe that data inside their firewalls are safe, what is outside is not. Business must drop this binary view. Cyber-criminals are beaching firewalls with minimal effort, so stronger and smarter defences are needed too. eHealth News Africa has covered security issues in several posts: Medical devices may not be secure enough, Cyber-crime worries for Cote d’Ivoire, Ghana’s cyber security strategy with ITU underway and Most health data breaches are cyber-crimes.

  • Microsoft’s IE has a bug

    If you’re using one of Microsoft’s Internet Explorer (IE) versions 6 to 11, you could be exposed to cyber-threats. The BBC has reported that Microsoft has warned users that these IE versions are vulnerable and hackers could gain access and user rights to their computers. There have already been limited, targeted attacks. Microsoft says it is eradicating the weakness. Users logged on with administrative user rights may enable an attacker who has successfully exploited the vulnerability to take complete control of an affected system.

    NetMarket Share, Internet statistics specialists, says the IE versions affected have more than 50% of the global browser market. This is a huge potential impact.

    Users should have received a security advisory notice. Actions“may include providing a solution through our monthly security update release process, or an out-of-cycle security update, depending on customer needs”. People still using XP won’t receive these updates because Microsoft ended official support earlier this month. Estimates are that about 30% of all desktops are still running Windows XP.

    IE on Windows Server 2003, Windows Server 2008, Windows Server 2008 R2, Windows Server 2012, and Windows Server 2012 R2 runs in a restricted mode, on Windows Server 2003, Windows Server 2008, Windows Server 2008 R2, Windows Server 2012, and Windows Server 2012 R2 runs in a Restricted Enhanced Configuration. It “mitigates this vulnerability.”

  • mHealth has a clear business case, says Vodacom

    Return on investment (ROI) is an economist’s way of saying, “why bother?” For eHealth, a socio-economic return (SER) is a way of including all stakeholders. Mojca Cargo of Groupe Speciale Mobile Association (GSMA) has found a reason for eHealth investment. Her report of the Vodacom’s Kirsten Miller-Duys’ presentation, “The role and value of mobile operators in mHealth” at an event in Johannesburg, South Africa, shows a way ahead. Vodacom’s view is that the business model depends on where mobile operators place themselves in five locations along the ICT value chain, from lowest to highest value:

    Communication system: one direction content pushInformation system: bi-directional information flowManagement system: support information design and auditDecision support system: assist clinical and admin decision-makingExpert system: intelligent cross-platform partnerships.

    The higher up the ICT value chain operators go, the more progression mHealth enables. Four reasons to be involved in mHealth are to:

    Diversify revenue streamsLeverage capabilitiesEnhance competitive differentiationImprove health outcomes.

    The Pan-African mHealth Initiative supports GMSA’s goals. One of objective is to demonstrate the business case for long-term investment in mHealth linked to sustainable partnership and collaboration opportunities for mobile and health stakeholders. There seems no shortage of enthusiasm. GSMA’s research in 2012 found that globally, 794 mobile operators had mHealth initiatives, and that 269 mHealth products and services were led by mobile operators. eHealth News Africa has identified an increasing change in emphasis from SMS-based mHealth towards clinical applications. When coupled with the changing role of community health workers, it strengthens the business case for mHealth in Africa.

  • Africa – a growing eLearning market

    By some estimates eLearning is already a $56 billion global industry, set to double by 2015. The US and European markets account for nearly 70%, with Asia-Pacific further contributing to the aggressive global growth.

    In Africa, a growing number of companies and industries are taking up eLearning for its success rate and its low cost of delivery. eLearning has rapidly evolved, and can do so much more than just maximize a company’s training impact. Retailers, financial services providers, mining groups and fuel companies are all taking advantage of eLearning with applications ranging from “sales and customer service training to induction courses, professional board exams, and even flight and surgical procedures training”.

    eLearning in healthcare is rapidly expanding and includes a range of initiatives and projects. From new devises such as Google glass, to nurse teaching programs in Kenya. The possibilities seem endless. Healthcare should grab hold of this opportunity to fully realize the potential of eLearning.

  • Architecture and IOp are the core of good health data

    “You cannot change your destination overnight. You can change your direction” is a view of the entrepreneur Jim Rohn. The MITRE Corporation, a not-for profit technology organisation in Virginia USA has a similar view with a sense of urgency. In A Robust Health Data Infrastructure, it says that effective software architecture and interoperability (IOp) are the keys and foundations of health data infrastructure, and it needs fixing within a year.

    MITRE proposes an urgent need for the USA to construct an architecture with core principles that:

    Is agnostic about the type, scale, platform, and storage location of the data Uses public Application Program Interfaces (API) and open standards, interfaces, and protocols Encrypts data at rest and in transit Separates management from data management Includes the corresponding metadata, context, and provenance information with data Represent data as atomic data with associated metadata Follows the robustness principle of being liberal in what’s accepts and conservative in what’s sent Provides a migration pathway from legacy EHR systems.

    Architecture has to incorporate a migration pathway from legacy software used to store and process EHRs to future systems of broad interoperability. APIs provide the pathways. API is a set of published programming instructions and standards for accessing web-based software applications and tools.

    “It also says that the lack of interoperability among the data resources for EHRs is a major impediment to the effective exchange of health information.” Using a common mark-up language is not enough. It needs published APIs too so that other software providers and users can link from current systems to future software ecosystems built on stored data.

    The Agency for Healthcare Research and Quality commissioned the report. Its goal is better quality, safety, efficiency, and effectiveness of health care for all Americans. It’s part of the USA’s Department of Health and Human Services.

    African countries planning EHRs and exchanging health information can learn and benefit from MITRE’s thinking, insights and proposals. It’s part of what Audre Lorde, a poet, referred to as “We are all in the process of becoming.”


  • The Pharmacology Science Gateway extends across Africa

    Sharing scarce resources can be beneficial, but it can be hard to assess. Antonio Porchia, the Argentinian poet, summed it up when he said “I know what I have given you … I do not know what you have received.”  The EU-project eI4Africa Pharmacology Science Gateway (PSG) seems clearer on the benefits of sharing.

    Its e-Science platform simplifies collaboration and sharing resources in Africa. The specific goals are to promote and implement African medical science collaboration on biomedical and pharmacological sciences and clinical trials and clinical drug studies to improve healthcare in Africa.

    The platform makes accessible open sources software for study designs, biomedical data processing and facilities for sharing data and discussing scientific and technical topics. It enables stronger north-south and south-south capacity and capability building as African researchers and their international collaborators have easy access and links to people dealing with similar challenges.

    PSG has six main activities:

    Genomics and bioinformatics Bioanalysis, drug analysis and metabolism Pharmacokinetics and pharmacometrics resources Clinical trial sciences Digital library Multimedia contacts and eLearning tools.

    The network includes the African Institute of Biomedical Science & Technology (AIBST), seven universities from six African countries. The PSG website lists them and the e14Africa supporters. They seem to know much about Antonio Porchia’s ideas, like “We become aware of the void as we fill it.”

  • Kenya releases its new ICT master plan

    Kenya has unveiled the national ICT Master Plan 2017, which will guide the country’s ICT direction for the next three years and spur on economic growth. The Master Plan was launched at the Connected Kenya Summit 2014 in Diani, and provides details on how these projects will be implemented, the timelines required and funding options.

    The policy document identifies three key ICT projects: a Citizen Service Portal, Government Shared Services and National Digital Registry Services.

    The Kenyan Government shows its commitment by increasing the ICT national budget allocation to 2.5%. It will continue to put aside more projects in the coming years until the country is on a par with international best practices. This could take several years, but Kenya is determined.

  • Smart pills anybody?

    We have all heard of smart phones, and smart TVs, but what about smart pills? According to Ariana Eunjung Cha, in Health & Science, many predict that smart pills will be at the forefront of a “revolution in medicine powered by miniature chips, sensors, cameras and robots with the ability to access, analyze and manipulate your body from the inside”

    Mary Ellen Snodgrass, is a 91 year old school teacher who swallows a computer chip everyday. It’s embedded in one of her pills and roughly the size of a grain of sand. When it hits her stomach, it transmits a signal to her tablet computer indicating that she has successfully taken her heart and thyroid medications. The smart pill technology allows her to view an hourly timeline of her day with images of white pills marking the times she ingested a chip.

    Snodgrass’s son, Doug Webb, a 62-year-old electrical engineer, can track his mother’s progress. He recently brought up a web page with his mother’s name with a multitude of charts and numbers.“Sometimes I see very strange numbers and I’ll call her up and say, ‘What’s going on?’ ” he said.

    This was the first smart pill to be approved by the Food and Drug Administration (FDA) and the European Union, in 2012 and 2010, respectively. It is still being tested by a handful of doctors and hospitals, as the company continues to refine its software. Proteus Digital Health, who developed the technology, hopes to make it more widely available within the next few years.

  • Can genetic diversity foil hackers?

    Standardisation is often seen as a solution to computer challenges and to many sorts of diversity. Charles de Gaulle once said “How can you govern a country which has 246 varieties of cheese?”Maybe he meant that 246 cheeses don’t offer enough diversity, although it’s a bit doubtful.

    If computer systems are a bit genetically diverse, like living organisms, will it make life harder for hackers and cyber-criminals? Michael Franz, a computer scientist at the Samueli School of Engineeringof the University of California (UCI) and Director of UCI’s Secure Systems and Software Laboratory says it can.

    His proposition is set out in an article in The Economist, and says that the slight genetic diversity in individuals helps to ensure that virus and bacteria attacks don’t destroy whole species. Applying the same principle to computer systems means that a compiler that creates minor variations to software can extensively inhibit hackers effectiveness.

    It’s not a new idea. Some applications that have high security requirements already use slightly different codes in different installations. Compilers work in a different way.

    They convert applications written in conventional languages into the machine code used by computer’s processors. Michael Franz’s solution is a mutli-compiler that can create billions of unique versions of the same original program. All test attacks have failed. This doesn’t mean that hackers are deterred forever, just that they’ll have to work out how to make their attacks more specific, and possibly, or even probably, have to put up with smaller scale attacks. Franz estimates the breach rate of his multi-compiler model is about one in a billion, so each bespoke attack would only affect a few computers globally. An estimate of the total number of computers globally is about 2 billion. There are over a million PC sales a year. On these scales, a multi-compiler as an effective deterrent can slow down the effect of hacking.

    The case for multi-compilers being the norm seems obvious. Will it’s genetic diversity be the next cyber-security solution? The late Maya Angelou, the poet and civil rights activist, may have seen it when she said “In diversity there is beauty and there is strength.”

  • Oracle sees Nigeria as its core country

    Oracle has identified Nigeria as its development centerpiece in Africa, according to a report in BiztechAfrica News. This shouldn’t come as too much of a surprise: Nigeria is now officially the largest economy in Africa and 26th largest in the world. The country’s economy is growing at a staggering rate, moving away from an agricultural dominant economy and into service sectors.

    Martin Peck, Sales Consulting Senior Director, Europe Middle East and Africa, said “We are determined to partner with the relevant organisations, government agencies to help develop the human capacity requirements. Now we are focusing so much on Africa and Nigeria will become a hub for all the activities that we are doing. We are going to do more on our internship programme through which we try to bring graduates on board, take them through some technical training and make them ready for jobs. So this is a very good opportunity for us to hire young people but of course in some cases, they complete the training and get fixed up in other companies. We are doing this not just for us an organisation but to also give back to society.”

    According to the company, more businesses and governments see ICT as a key component of economic growth, recognizing that ICT skills development is vital if they are to take advantage of the new opportunities IT provides.

    Oracle works closely with established educational institutions in countries the world over to help young people develop the skills needed in their local marketplace. The Oracle Academy supports some 268,000 students in 1,800 education institutions across Africa. It is already a well-established part of Africa’s eHealth landscape.

  • Will the Internet of Things be routine by 2025?

    Eleven years from now, the Internet of Things (IoT) will be commonplace, says a report from the Pew Research Center. It brought several experts together who said that the rise of embedded and wearable computing will bring the next revolution in digital technology. For health and healthcare, it says that many people will wear devices that enable them to connect to the Internet and provide feedback on their activities, health and fitness. They will also be monitoring other people, such as their children, parents or employees, who also wearing the devices.

    Other changes include:

    Homes where people can control almost everything remotely, from heating and cooling, when their gardens are watered and with sensors that warn about events like prowlers to broken water pipes Communities with embedded devices and smartphone apps that enable more efficient transportation, provide updates on pollution levels, deliver electricity and water more efficiently and warn about infrastructure problems Goods and services where factories and supply chains have sensors and readers that track materials precisely so quicken and smooth the manufacture and distribution of goods An environment with real-time readings from fields, forests, oceans, and cities about pollution levels, soil moisture, and resource extraction that allow for closer monitoring of problems, including health priorities.

    The technology change that will deliver this is likely to comprise:

    The IoT, a global, immersive, invisible, ambient networked computing environment built through the continued proliferation of smart sensors, cameras, software, databases, and massive data centres Augmented reality enhancements to the real-world input that people perceive through their use of portable, wearable and implanted technologies Disrupted business models that were established in the 20th century, especially finance, entertainment, publishers and education Tagging, databases, and intelligent analytical mapping of physical and social realms.

    Some simple facts are:

    In 2008, the number of Internet-connected devices first outnumbered the human population In 2013, there were 13 billion Internet-connected devices In 2020, there will be 50 billion.

    Charles Babbage, the 19th century polymath and acknowledged inventor of a programmable computer, said that “Errors using inadequate data are much less than those using no data at all.” It seems impossible to avoid data. Incidentally, Charles Babbage was a forerunner of sex equality. He employed Ada Lovelace, a mathematician and daughter of Lord Byron, the English poet. She’s recognised as the first female programmer.

    Eleven years isn’t long for African countries to put the IoT infrastructure in place.

  • Samsung responds to ICT challenges in Kenya

    Samsung continues to expand its efforts to improve learning and education through the use of ICT in the remote areas of Sub-Saharan Africa. It recently launched the Solar Powered Internet School (SPIS) in Kenya in a bid to address insufficiency by providing learning material, low electricity connectivity as well as access to ICT’s in public schools. Samsung’s Vice President for East and Central Africa, Mr. Robert Ngeru, said the intervention is part of the company’s global vision of strengthening the minds and fostering the creativity of young people in Africa.

    The SPIS at Arap Moi Primary School is set to benefit nine other nearby schools; Kiserian, Nakel, Naro Moru, Nkoroi, Ole Kasasi, Oloosurutia, Olteyian and Rongai Primary Schools.

    The SPIS are fitted with solar powered panels to produce the power to run the technology inside which includes, net books, multifunction printer and Internet Protocol (IP) camera for remote monitoring to support teachers and enhance the learning experience of learners. The schools are also specially customised to endure conditions of remote areas.

    Intel and Korea Education Research Information Service (KERIS) joined Samsung by installing content on the computers. Educators will also be equipped with the necessary skills in curriculum development as well as integrating technology within the syllabus. The collaboration of Samsung and Safaricom to facilitate connectivity for information and research also plays a very important part to enhancing learning.

  • Healthcare isn’t up to cyber-threats

    If healthcare in the USA isn’t well-tooled up for cyber-security, what chance do African countries have? A USA approach to a cyber-threat simulation is in CyberRX: HITRUST Health Industry Cyber Threat Exercise  report by the US Department of Health and Human Services (HHS) and the Health Information Trust Alliance (HITRUST). A summary of the findings are in Results of first cyber-attack simulation point to need for collaboration, a Clinical Innovation + Technology blog.

    CyberRX is seen as essential as part of the security response to the growth of connected technologies in healthcare. It’s a complex exercise. A steering committee overseen by Booz Allen Hamilton designed the CyberRX simulation. It was applied to a wide range of healthcare activities, including providers, health plans, prescription benefit managers, pharmacies, HITRUST Cyber Threat Intelligence and Incident Coordination Center HITRUST C3 and HHS.

    The CyberRx goals included:

    Build awareness of cyber threats Explore responses to maintain operations that face complex risks Understand systematic risks to patients from disruptions Promote information sharing about cyber-attacks.

    Findings include:

    Healthcare organizations have the technical skills and knowledge to deal with threats, but collaboration is inadequate Cyber-threat simulations prepare organizations to deal with the real thing, even when they have mature and comprehensive information programmes Preparation for the real thing benefits from better threat intelligence, processing capabilities and wide stakeholder engagement Better capabilities for incident response coordinating and collaborating incident response s are crucial Organization should communicate and collaborate during cyber-crises and take a view across the whole healthcare system A generic national cybersecurity framework is insufficient for healthcare organizations facing the current types and range of cyber-threats It’s hard to share cybersecurity information and removing the barriers needs long-term solutions that include legislation and policy changes.

    It’s obvious that resources for eHealth cyber-security in Africa are nowhere near those available in the USA, so Africa needs different solutions. They include better user training, relying more on ICT suppliers, training more cyber-security specialists, learning from other countries, especially the USA and better eHealth regulation. It’s a big agenda, but cyber-attacks have big, damaging consequences.

  • Track outbreaks with Twitter! Google, or Wikipedia.

    There’s a new race underway between Internet giants Google, Wikipedia and Twitter. It’s anyone’s guess who might be winning, but from an outsider’s viewpoint they are all doing rather well.

    Google’s been estimating flu trends for some time. But not many expected the announcement that Wikipedia estimated peak Influenca-like illness (ILI) activity 17% more often than Google Flu Trends. eHealth News Africa’s Tom Jones wrote about this in April, including a P LOS Computational Biology headline “Wikipedia Usage Estimates Prevalence of Influenza-Like Illness in the United States in Near Real-Time.” PLOS is a non-for-profit open access scientific publishing project.

    Two months earlier, Matt Petronzio at Mashable, a top social media news outlet reported that a team of researchers at the University of California, Los Angeles (UCLA) found that Twitter and other real-time social media can be used to track HIV outbreaks and drug behavior. It has a big potential to help to detect and prevent infection.

    Preventive Medicine published the study, suggesting a link between geographic outbreaks in the USA and tweets with phrases that indicate drug-related and sexually risky behaviour. Sean Young, co-director of UCLA’s Center for Digital Behavior, said in a statement, “This is the first [study] to suggest that Twitter can be used to predict people’s health-related behaviors and as a method for monitoring HIV risk behaviors and drug use.”

    Whichever horse you’re betting on, it’s sure to be an exciting race. Could they all come in first?

  • Zambia to use analytics to improve access to life-saving drugs

    IBM will soon be collaborating with the Zambian Ministry of Health (MOH) to provide citizens with improved access to some 200 life-saving drugs. The initiative has the support of the World Bank, the Department for International Development, UNICEF and London Business School. Zambia’s Medical Stores Limited (MSL) will deploy the new medical supply chain pilot using sophisticated analytics and mobile technologies to manage medicine inventory and delivery.

    Every year, Zambia’s public health sector records nearly 100,000 deaths that are caused by preventable and treatable diseases. The medicine supply chain management project aims to save more lives by making life saving medicine available when and where it’s needed.

    The pilot will manage a scalable supply chain and control the use, supply, availability and access to essential medicine within the country’s health sector. The solution will also provide real-time view of drug use and stock levels, and analyze data to identify trends and forecasts to prevent gaps in the medical supply chain.

    “With help from our partners, we have already introduced simple improvements in the medical supply chain that will save the lives of thousands of children across our country by 2015,” said Dr. Bonface Fundafunda, CEO at MSL. “To build on these gains, we’re working with IBM to replace our paper-based inventory system with cutting-edge technology that can pinpoint the exact locations where stocks of essential medicines are running dangerously low.”

    IBM was recently involved in a similar project to combat the number of deaths from malaria in Tanzania. The “SMS for Life” solution was successfully piloted in 135 villages and has now been rolled out across the whole of Tanzania.

    The 12-month pilot project kicks off this month and hopes to contribute to the overall strengthening of Zambia’s health care system.

  • Copy and paste: is it the big risk for EHRs?

    When patients visit their doctors, do they think that their doctors listen to the concerns and review the specific signs and symptoms of each patient and record them in unique notes, or do doctors categorise them and save time by copying and pasting text to record typical complaints and treatment plans? If the treatment options are limited, is it reasonable to expect that signs, symptoms and diagnoses are in a narrow band too? Either way, copying and pasting brings with it increased security risks.

    In the USA, the Department of Health and Human Services’ Office of Inspector General has reviewed these practices in the Centers for Medicare & Medicaid Services (CMS) and produced CMS and its Contractors Have Adopted few Program Integrity Practices to Address Vulnerabilities in EHRs. It found that:

    EHRs can make it easier to commit fraud such as using some EHR to conceal true authorship of medical records and distort information to inflate health care claims The transition from paper records to EHRs may present new vulnerabilities and require the CMS and its contractors to modify their techniques for identifying improper payments and investigating fraud CMS and its contractors had adopted few program integrity practices specifically for EHRs Few contractors were reviewing EHRs differently from paper medical records Not all contractors said they could determine whether a provider had copied language or over-documented in a medical record CMS had provided limited guidance to Medicare contractors on EHR fraud vulnerabilities.

    Over-documentation is a USA term meaning inserting false or irrelevant documentation to create the appearance of support for billing higher-level services than provided. Identifying over-documentation increased from 78% to 83% with EHRs. Identifying copied language with EHRs dropped from 61% to 50%.

    Of the contractors, 22% conducted additional reviews. About 17% used data from audit logs.

    The report recommends that CMS should:

    Compile and provide guidance to its contractors on detecting fraud in EHRs Work with contractors to identify best practices and develop guidance and tools for detecting fraud in EHRs Direct its contractors to use providers’ audit logs.

    As African countries introduce and expand their use of EHRs and related eHealth, it’s a good idea not to switch paper-based practices into them without a thorough, rigorous review of their use and implications.